The Person-Centered Care Toolkit (PCCT) is a resource for providers to teach concepts for a person-centered approach to care for older adults across health care settings. Tools and techniques are part of a three-fold approach of the toolkit that includes:
- Teaching tools for interprofessional healthcare providers,
- Activities to enable older persons to express themselves and their creative potential, and
- Self-care techniques for health care professionals to reenergizes and maintain their ability to provide a person-centered approach to care.
The PCCT is organized around the conceptual framework for Person-Centered Care developed by the Washington, D.C. Geriatric Education Center Consortium (WAGECC) as a way to teach person-centered care for health care professionals. The model serves as a guide for developing geriatric and gerontology curriculum, teaching, and evaluating outcomes of WAGECC programs.
The toolkit is easy to follow, can be applied across health care settings, and builds on the foundations of the creative arts, imagination, and playfulness through multi-arts expression. Each activity includes objectives, target audience, description of the exercise, expected outcomes, possible adaptations and how it has been used to date by WAGECC faculty. It nurtures the skills of observation, empathy, communication, listening and self-reflection to support health care providers and those they care for in gaining insight into human nature including healing, illness, suffering, creativity and personhood.
Faculty members have been collecting, using and documenting the value of experiential activities in humanities and creative arts for the Person-Centered Care Toolkit that addresses various older adult issues and concerns. The toolkit will be maintained on the WAGECC website for access by educators. The framework is comprised of six core elements.
Toolkit Core Elements
The first core element of the toolkit is the engagement of the older adult and his/her family (or those of primary significance to the older adult) in a partnership to address healthcare concerns. This includes:
- Education for the older adult and family to be able to make health care decisions and participate in his/her care;
- Anticipatory guidance for maintaining their quality of life;
- Addressing developmental challenges and potential problems along the life trajectory.
This may involve education in the use of online information and healthcare professionals need to be skilled to incorporate tools such as health coaching, motivational interviewing, decision aids, technology support, family presence in rounds, preference-sensitive decision-making and other emerging tools to foster greater engagement by patients and their families (Scholle, et al.).
There are a wide variety of ways to approach teaching about the engagement of the older adult (and his/her family if available) as an important element of Person-Centered Care, including Dimensions of Personhood.
Scholle SH, Torda P, Peikes D, Han E, Genevro J. Engaging Patients and Families in the Medical Home. AHRQ Publication No. 10-0083-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2010.
The second core element is respect for the preferences, values and beliefs, including cultural attributes. The healthcare professional needs to build a relationship to discern what gives each individual hope and the sense of quality of life. The older adult’s hopes and dreams will vary based on his/her own values and beliefs. Each person has a unique sense of what gives life beauty and joy, which may also be an expression of his/her culture. When the healthcare professional utilizes the humanities to gain a better understanding of their own experiences as a healthcare provider, it reinforces the value of the humanities for understanding the human experience of the older adult, his/her family, and even the healthcare colleagues who collaborate to provide comprehensive and supportive healthcare.
Exercises to teach respect for the preferences, values and beliefs include:
A third core element is communication, especially to create space for the individual and family to discuss medical and health concerns, as well as their fears, hopes and anxieties. Healthcare professionals can engage the older adult and family in discussions for goal setting and advanced care planning, including
breaking bad news in a sensitive manner and setting, holding difficult discussions in compassionate and supportive ways, and addressing family conflicts.
A basic tenet of communication with older adults and families is respect for each individual as a person. When facing life-threatening illness, people want to feel listened to, cared for, and to be known as people rather than diseases. Showing empathy, thoughtfulness, acceptance, respectfulness, and patience can help older adults feel supported as they make decisions that impact their quality of life. Another key strategy to help healthcare professionals view the older adult as someone with potential and not a healthcare problem is to engage the individual and family to discern strengths that facilitate their life journey. This involves active listening as well as encouraging the sharing of narratives and stories of the older adult to build positive relationships.
Exercises to teach communication, include:
- Attitudes About Aging (PDF)
A fourth core element is recognition of the importance of comfort and supportive care for older adults and their families. This must include the sensitivity to non-medical needs such as the need for spirituality and meaning-making as well as the possibility of suffering. Holistic modalities can be employed that support well-being and focus on self-awareness and self-expression, relaxation, joy and well-being.
Exercises to teach holistic care, include:
The Last Decision (PDF)
Another core element is attention to the coordination and integration of care for older adults across all setting. There must be accountability by each healthcare professional to ensure safety, security, and personhood during transitions in care across settings, including home, hospital, nursing homes, rehabilitation, etc. This accountability must extend to all providers communicating the plan of care, goals of care, treatment concerns, etc. to other healthcare professionals involved in the care of any one older adult. This requires team building and interdisciplinary collaboration. It also behooves the healthcare professionals to engage in nurturing self, team members, and collaborators to enhance their resilience as caregivers.
The final core element is recognition of the importance of community outreach and involvement for maintaining function, independence, and quality of life for older adults. There must be:
- System supports for person-centered care,
- Societal awareness of the importance of opportunities for creative expression in the community and healthcare settings for lifelong learning for older adults,
- Opportunities for spiritual and social engagement, and
- Opportunities for continued growth and development Transitions in Care.